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Download Contrast Agent and Radiopharmaceutical Billing Codes Hospital
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Mallinckrodt Hospital & Freestanding Setting Contrast Agent and Radiopharmaceutical Billing Codes Select contrast agents and radiopharmaceuticals are eligible for separate reimbursement under the Medicare program in the physician office/freestanding imaging setting. Check with the local Medicare Contractor for additional information. In the hospital outpatient setting, under the Medicare program, generally, the cost of a contrast agent or diagnostic radiopharmaceutical is considered and then included into the payment rate for the procedure under the Medicare Hospital Outpatient APC program. Per CMS transmittal 23861 (item #5a page 5, 1/13/2012) “Hospitals are strongly encouraged to report charges for all drugs, biologicals, and radiopharmaceuticals, regardless of whether the items are paid separately or packaged, using the correct HCPCS codes for the items used. It is also of great importance that hospitals billing for these products make certain that the reported units of service of the reported HCPCS codes are consistent with the quantity of a drug, biological, or radiopharmaceutical that was used in the care of the patient. More complete data from hospitals on the drugs and biologicals provided during an encounter would help improve payment accuracy for separately payable drugs and biologicals in the future. CMS strongly encourages hospitals to report HCPCS codes for all drugs and biologicals furnished, if specific codes are available. CMS realizes that this may require hospitals to change longstanding reporting practices. Precise billing of drug and biological HCPCS codes and units, especially in the case of packaged drugs and biologicals for which the hospital receives no separate payment, is critical to the accuracy of the OPPS payment rates for drugs and biologicals each year.” Non-Medicare and Private Payer policies regarding contrast and radiopharmaceutical reimbursement vary. Check with the local insurer for more information. 1 http://www.cms.gov/transmittals/downloads/R2386CP.pdf The material referenced and provided is based upon research of current Medicare reference sources. The final decision of billing for any product or procedure must be made by the provider of care considering the medical necessity of the services and supplies provided, the regulations of insurance carriers and any local, state or federal laws that apply to the supplies and services rendered. We are providing you this information in an educational capacity with the understanding that we are not engaged in rendering legal, accounting or other professional services. Contrast Agent and Radiopharmaceutical Billing Codes Suggested Coding Code and Description Published Verbatim from Medicare’s Internet Site1 Commonly Known As Contrast Agents A9579 Injection, Gadolinium-Based Magnetic Resonance Contrast Agent, per 1 mL Optimark™ Gadoversetamide Injection Q9954 Oral Magnetic Resonance Contrast Agent, per 100 mL Gastromark™ Ferumoxsil Oral Suspension Q9958 High Osmolar Contrast material up to 149 mg/mL iodine concentration per 1 mL Conray™ 30 Iothalamate Meglumine Injection USP 30% Q9958 High Osmolar Contrast material up to 149 mg/mL iodine concentration per 1 mL Cysto-Conray™ II Iothalamate Meglumine Injection USP 17.2% Q9960 High Osmolar Contrast material 200-249 mg/mL iodine concentration per 1 mL Conray™ 43 Iothalamate Meglumine Injection USP 43% Q9961 High Osmolar Contrast material 250-299 mg/mL iodine concentration per 1 mL Conray™ Iothalamate Meglumine Injection USP 60% Q9963 High Osmolar Contrast material 350-399 mg/mL iodine concentration per 1 mL MD-Gastroview™ Diatrizoate Meglumine and Diatrizoate Sodium Solution USP Q9963 High Osmolar Contrast material 350-399 mg/mL iodine concentration per 1 mL MD-76R™ Diatrizoate Meglumine and Diatrizoate Sodium Injection USP Q9966 Low Osmolar Contrast material, 200-299 mg/mL iodine concentration, per 1 mL Optiray™ 240 Ioversol Injection 51% Q9967 Low Osmolar Contrast material, 300-399 mg/mL iodine concentration, per 1 mL Optiray™ 300 Ioversol Injection 64% Q9967 Low Osmolar Contrast material, 300-399 mg/mL iodine concentration, per 1 mL Optiray™ 320 Ioversol Injection 68% Q9967 Low Osmolar Contrast material, 300-399 mg/mL iodine concentration, per 1 mL Optiray™ 350 Ioversol Injection 74% Radiopharmaceuticals 1 A9500 Technetium Tc-99m Sestamibi, diagnostic per study dose Sestamibi, Cardiolite® A9505 Thallium TI-201 Thallous Chloride, diagnostic, per millicurie Thallium A9509 Iodine I-123 Sodium Iodide, diagnostic per mCi A9512 Technetium Tc-99m Pertechnetate, diagnostic, per mCi A9516 Iodine I-123 Sodium Iodide Capsule(s), diagnostic, per 100 microcuries, up to 999 microcuries A9517 Iodine I-131 Sodium Iodide Capsule(s), therapeutic, per millicurie A9528 Iodine I-131 Sodium Iodide Capsule(s), diagnostic, per millicurie A9529 Iodine I-131 Sodium Iodide Solution, diagnostic, per millicurie A9530 Iodine I-131 Sodium Iodide Solution, therapeutic, per millicure A9531 Iodine I-131 Sodium Iodide, diagnostic per microcurie, (up to 100 microcuries) A9538 Technetium Tc-99m Pyrophosphate, diagnostic per study dose, up to 25 millicuries PYP A9556 Gallium Ga-67 citrate, diagnostic, per millicurie Gallium A9560 Technetium Tc-99m Labeled Red Blood Cells, diagnostic, per study dose up to 30 millicuries Ultratag A9561 Technetium Tc-99m Oxidronate, diagnostic, per study dose, up to 30 millicuries HDP A9562 Technetium Tc-99m Mertiatide, diagnostic, per study dose, up to 15 millicuries MAG3 A9572 Indium In-111 Pentetreotide, diagnostic per study dose, up to 6 millicuries Octreoscan TM TM TM TM http://www.cms.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp#TopOfPage For more information, contact: • Local Covidien Representative: 800-634-1515 • Customer Service: 888-744-1414 • http://imaging.covidien.com COVIDIEN, COVIDIEN with logo and Covidien logo are U.S. and internationally registered trademarks of Covidien AG. Other brands are trademarks of a Covidien company or their respective owner. © 2011 Covidien. Rev. 03/2012 Mallinckrodt The material referenced and provided is based upon research of current Medicare reference sources. The final decision of billing for any product or procedure must be made by the provider of care considering the medical necessity of the services and supplies provided, the regulations of insurance carriers and any local, state or federal laws that apply to the supplies and services rendered. We are providing you this information in an educational capacity with the understanding that we are not engaged in rendering legal, accounting or other professional services.
